R414-516-7. Quality Metrics

  (1) A program may earn up to six QI points for demonstrating quality metric scores equal to or better than the industry average noted.

  (a) Quality metrics shall include:

  (i) CMS 5-Star quality measure rating, for long-stay residents, obtained from CMS online data sources. The industry average is 3.62. To qualify, the nursing facility program must equal or exceed the industry average.

  (ii) CASPER Quality Measures for urinary tract infections obtained from CMS online data sources. The industry average is 6.68%. To qualify, the nursing facility program must have less than or equal to the industry average.

  (iii) CASPER Quality Measures for pressure ulcers obtained from CMS online data sources. The industry average is 6.15%. To qualify, the nursing facility program must have less than or equal to the industry average.

  (iv) CASPER Quality Measures for falls with a major injury obtained from CMS online data sources. The industry average is 4.17%. To qualify, the nursing facility program must have less than or equal to the industry average.

  (v) Nurse staffing hours per resident day obtained from CMS online data sources. The industry average is 3.81. To qualify, the nursing facility program must equal or exceed the industry average.

  (vi) Survey deficiency scope and severity obtained from the Utah Bureau of Health Facility Licensing, Certification and Resident Assessment. The industry average is 3.57. To qualify, the nursing facility program must have less than or equal to the industry average.

  (b) A program may earn QI points as follows:

  (i) Four QI points may be earned for achieving metrics scores equal to or superior to the industry average in greater than four of six targets;

  (ii) Three QI points may be earned for achieving metrics scores equal to or superior to the industry average in four of six targets; or

  (iii) Two QI points may be earned for achieving metrics scores equal to or superior to the industry average in three of six targets.

  (c) A program may earn QI points from demonstrating metrics score improvement as follows:

  (i) Two QI points may be earned by demonstrating metrics score improvement in greater than four of six targets; or

  (ii) One QI point may be earned by demonstrating metrics score improvement in four of six targets.

  (2) One QI point may be earned by demonstrating a 20% improvement in two specific quality metrics scores on the CASPER report at the end of the 12-month data (October through September) period as compared to the prior 12-month data period.